It’s not a surprise that those of us in international development organizations, like most everyone who cares about the survival of the planet, are profoundly concerned about the next four years (translation: sobbing hysterically into our morning cereal). Yes, we griped plenty about the slow pace of change in the Obama administration – for example, it took AGES to get a USAID administrator, and to change some particularly egregious Bush administration policies, such as the abstinence preferences in HIV programs. And activists critiqued and condemned the Obama administration’s policies on a variety of international humanitarian and development issues – that was our job.

At the same time, there was undeniably immense progress on “doing development right.” Here we are eight years later, and USAID has implemented a strong gender equality policy, integration of family planning and HIV services is a reality, groups that discriminate against LGBT persons are no longer given a free pass, climate change is seriously considered in a range of development programs, and local partners are increasingly consulted and included.

It’s not perfect, but we have learned a tremendous amount about how to do development well in the last eight years. Our challenge now is making sure this understanding is not jettisoned in our quest to adapt to the incoming administration.

How do we as development professionals and advocates, who are motivated by doing good in the world but also motivated by retaining our jobs, staying in business and (in some cases) making a profit – not get infected by an administration whose most powerful members reject evidence and/or hold repellent beliefs about much of the world? How do we inoculate ourselves against an America-First, “anti-globalist” ideology that replaces compassion and respect for human rights with a shortsighted and crass centering of U.S. profit and security?

These are not theoretical questions. There are going to be real decisions about cooperation versus resistance in the next four years – and frankly, the U.S. development community does not have the strongest of records in speaking truth to power. There are justifiable reasons for collaboration when the good we do in other countries outweighs the sacrifices of going along with bad policy. But we need to decide where the lines are – when no investment (or an investment in another contractor) is better than one that distorts our principles and betrays the people we are supposed to serve.

We will establish our complicity or our resistance through specific decisions. Do we integrate attention to gender in our work, even when it’s not required? Do we continue to talk to and work with organizations that provide abortion care, or do we turn our backs out of fear and an over-interpretation of the Global Gag Rule? Do we tell our HIV providers to stop offering family planning? What about serving LGBT groups, and protecting LGBT employees? Do we stop talking about and planning for climate change when it’s no longer a priority? Will we continue to see structures and systems as barriers to health, education, and economic success, or will we lapse back to thinking individual behavior alone determines success or failure? Will we help human rights groups raise the alarm by providing the evidence of poor policy and cruelty that we will have in spades, or do we stay silent?

The Trump administration will leave deep, deep wounds on the world. As development professionals and human rights advocates, we can be the connective tissue that helps knit the world back together – or we can be the scarring that takes on the exact shape of the wounds that he creates. The Trump administration will not be all-powerful without acquiescence. The people around the world we work with will either see us as a reflection of him, or his antithesis. Will we let his leadership define who the American people are?

In my optimistic (not crying in my cereal) moments, I see this as an opportunity. Our democracy is on life support, our rule of law is questionable, our domestic commitment to gender equality is laughable, our respect for human rights is intermittent. Perhaps this – our greatest moment of weakness — is precisely the moment in which we can transform our approach to international development. Maybe this is an opportunity to make a shift – tonal and structural – that tells people around the world that we don’t know better. We are just trying to figure this all out too. Maybe out of this profound lack of normalcy, we can be WITH the world instead of pretending that we’re the experts. Perhaps – even in the face of personal and professional risks — resistance and solidarity within the international development community will become our best legacy for the world.

Excuse me for a little minute while I go off, and apologies in advance for some swears:

Today is September 14, 2016. And here is the truth: polls are showing a dangerously thin margin between a competent and dedicated public servant and someone who has zero qualifications for the presidency and negligible interest in policy. That truth makes me want to put my head in a hole for the next two months.

But today is not the day to despair, bitches.

The day to despair *would be* November 9, 2016, if on that day we realize that we have not done everything in our power to shout YES! to a rational candidate and NO! to a sociopath. If on that day, we realize that we posted a bunch to Facebook, but didn’t talk to a single live undecided voter about why we think Hillary is the best choice, that will be the day to despair. The days to despair would be all those days coming after, if we were to realize that we spent more time thinking about where to move if an egomaniac is elected president than we did making phone calls, or knocking on doors, or registering new voters.

Nope. Today is not the day to despair. Today is the day to get this thing done. Today is the day that we decide to channel our anger and worry and stress into energy and enthusiasm and commitment.

Today is not the day to put our hands over our ears and la-la-la our way to November.

And today is not the day that we sit back and complain about the New York Times, or wonder why Hillary isn’t doing this or doing that.

This is our freaking democracy and yes, the media is a pain and yes, there is a whole giant basket filled with deplorable people on Twitter and Facebook, but this is OUR freaking democracy. And there are people whose lives will be devastated in very real ways if he wins. That is what is at stake. And if we decide to despair on this day, there is no way we are going to win.

Today is the day that we kiss our families goodbye until November, or drag them along behind us door to door, because we’re doing this for our kids. Today is the day that we go to the Hillary Clinton website and we order that damn sign (or I will seriously order one for you if you want) because even if you live in the bluest or reddest state in the country, that shit matters. Enthusiasm matters. Wearing the button, putting on the bumper sticker, talking to people in the grocery store – being loud and proud about supporting an actual super intelligent and experienced woman for the presidency – that matters.

The time for sitting is over. The time for being shy about this is over.

We know that bitches get stuff done. Let us freaking get this shit done, bitches.

The news about the Obama’s Administration’s overtime pay change took a few days to sink in for me. I didn’t immediately see it for what it was – a policy shift that would bring into sharp relief an issue that has been a constant thread in my career: how social justice nonprofits treat the people who work for them, what it reveals about their double standards, and what the implications are for gender equality.

The new policy mandates that employers must pay overtime to anyone making less than $47,500 per year and working over 40 hours per week. This has put some social justice nonprofits in an uncomfortable position. Nonprofits like U.S. PIRG have spoken out against the new rule, saying it should only apply to for-profit entities, and claiming that it would lead to nonprofit staff cuts. The director of PIRG said that those doing “mission-driven” work do not need the same protections as people at, say, McDonalds (the vast majority of whom I believe were already eligible for overtime pay).

This kind of ethical contortion (MY workers don’t need protection, only YOURS do) is unfortunately not surprising to me. Over the past 25 years, I have experienced the good and bad of working at social justice nonprofits. It has taught me some important yet devastating lessons about the ability of many nonprofit leaders to promote equality and human rights outside their organizations, while turning a blind eye, or worse, to the treatment of their own employees.

Like so many young progressives, I spent a summer canvassing in college. The group was working to end nuclear proliferation and testing (yes this was a long time ago), and daily sent me and my peacenik colleagues from Ann Arbor to the Detroit suburbs to raise money and awareness. But mostly money. The organization made it clear what it valued – you didn’t earn an hourly wage, or even compensation based on how many petition signatures you got. You got a percentage of your nightly fundraising. Even if you were doing great educational work going door-to-door, building name recognition for a pretty obscure organization, the organization only placed value on that work if you also brought in money.

There was also the human rights organization that I spent two years volunteering for in college – a position that was unpaid, for which I received no college credit. I was hopeful about getting a job there when I graduated – during my junior year abroad I had worked on human rights and served as a research associate for the organization’s founder. Coincidently, they had a job opening timed just when I was graduating – for a barely-survival-income, entry-level position, which I figured I was perfect for. So I was pretty disappointed when the director called me into his office to tell me that they had decided that instead of hiring me, they were opting for a religious volunteer – saving them about $6,000 in annual salary. There was some comfort – I had seen the crazy hours their entry-level staff worked, and knew that it would have been challenging if not impossible to pay DC rent on the salary they offered.

I could go on at great length – with things I’ve experienced or heard from others. The place I worked that promoted volunteering – yet didn’t have a comp time policy and required weekend work, so program staff couldn’t volunteer themselves. The child welfare organization that didn’t let employees go part time or have flex-time to be home with kids. The leaders of social justice organizations who regularly yell at and disrespect their employees. And so many (SO many) feminist organizations that, in different ways, show contempt for the young and fabulous feminists who work for them, or pay less-experienced men more than the women they replace.

But there have also been people who have shown real leadership on these issues. I remember one of the members on the board from my full-time job out of college, who was horrified by our miniscule salaries, saying the organization simply needed to just write higher salaries into our budget proposals (I still think many organizations just don’t think to do that). Working for the League of Women Voters out of grad school taught me the value of a union – I worked for the 501c3 side of things, but the 501c4 union had negotiated a 35-hour week and comp time, which we also benefited from. There are organizations that cap executive salaries in relation to those at the lowest rungs. These experiences reminded me that I could expect more – that not all nonprofits depend on heavy demands made of young professionals for poor compensation. That some nonprofits see organizational values as something they must embody internally, as well seek externally.

Of course, I was never in it for the money – as the PIRG director says, this was mission-driven work, and I felt (feel) a calling to contribute to human rights and gender equality. But too often, I have seen the passion for social change turned into a weapon against the very people who do much – if not most – of the hard work, and put in most of the hours. Because they are highly motivated by passion, the reasoning goes, they don’t need to be motivated by decent salaries or sustainable work hours or overtime pay. (This type of argument tends to go out the window when you reach the CEO level, strangely enough.) And how do you suppose that feels to young professionals with a college or graduate degree, living in a group house and barely affording student loan payments?

That nonprofit leaders – especially those working for social justice – don’t see the fundamental absurdity of this argument is very hard to swallow. What these leaders are showing is a blatant double standard, and what they are saying is a huge “screw you” to their employees – and in particular to young women.

As of 2011, women were three of every four employees in the nonprofit sector. At the levels applicable under this new rule (earning below $47,500) the proportion of women is likely even higher, because we know that women are underrepresented at top levels in the sector. (For example, a 2014 report found that men are 90 percent of the presidents of the largest conservation organizations.) So when any nonprofit leader says that his lower-paid workers shouldn’t get overtime, what he’s really saying is that female employees should not be paid overtime.

When you zoom out, this is what you see: a nonprofit sector fueled by the time and talents of young women, who have likely passed up opportunities to work for higher salaries elsewhere so they can pursue a passion for social change. Far too often, nonprofit leaders have been telling them their commitment to social justice will not be rewarded beyond the warm, fuzzy feeling of doing good. We can do better, and it appears that thanks to the Obama Administration we finally will.

Maybe it’s just my own personal Hamilton-mania talking, but it feels like we’re living in a revolutionary time.

Even if not quite revolutionary in the precise political science definition of the word, it is at least a moment brimming with possibility.[i] In sharp contrast to every other election in my lifetime, tackling inequality is among the fundamental urgencies driving voter decisions in the U.S. Democratic Party primaries. People seem to have their eyes fully open to the degree of transformation they are asking for, if not all the potential consequences. After all, disrupting the layered and interwoven financial and political systems that are sustaining (and sustained by) economic, social, gender, and racial inequality would be nothing short of tectonic.

But then, George Washington, in all his post-Cabinet-rap-battle wisdom,[ii] pulls me back to reality. Winning – whether it’s a war or an election – is easy, and governing is indeed harder. Politics is inevitably messy, and we often have to settle for better instead of best, as President Obama recently expressed so well in a speech to Howard University grads.

It is this tension between visionary idealism and incremental change that divides so many of those I know on the left. I’m not interested in writing another Bernie vs. Hillary piece, but just to boil it down: In Bernie Sanders, many see a refreshing break from politics-as-usual, a bold truth-teller, a debate changer, a person who can be trusted to take principled stands. While Hillary Clinton’s policy proposals share many of the same values, the course she articulates is consistently more measured. Many of her supporters see this as a more reasonable approach in line with current political realities.

Ideally, we would have both – a political leader who inspires broad support by igniting the fire of the possible in us, while deftly navigating a thorny political atmosphere by outsmarting opponents and (yes, sometimes) making deals. But if we cannot have both of those in one package, then the deft navigator is more important. It all comes down to the roles of government vs. civil society in creating progressive change.

Throughout history, progressive civil society organizations in the U.S. (as elsewhere) have worked separately and in concert to voice dissent, reveal oppressions, propose alternative political and economic visions, mobilize support, craft policy solutions, and hold authorities accountable to progressive policies and laws. It is essential that movement protagonists sit outside of government. This ensures at least a modicum of independence from government and party interests and pushes the boundaries of debate beyond what is politically accepted at the moment. It also allows civil society to play that watchdog role that is so essential – even (or especially) when a friendly political party holds power. Principled, well-articulated demands from civil society meet the political reality of negotiated progress. It’s usually not pretty, but it’s what has worked.

So when people talk about “revolution” in the context of a presidential campaign, I get nervous – mostly because I don’t believe it’s the role of a U.S. president to embody revolution. Why do we want so desperately to believe that one person at the executive level has to be the vanguard? Why do we give that power away from ourselves?

I also get nervous because many of the people supporting the revolution against inequality don’t seem to be as concerned about racial and gender inequality as they are about economic inequality – as if race and gender will sort themselves out once the economics are taken care of.[iii] Those most affected by economic and political inequality (people of color, especially women) are not the primary protagonists of this revolution, and that raises all kinds of questions about authenticity. Would their voices be lost when choices inevitably have to be made?

There’s also a practical reason for the president to not be the leader of the revolution. Pitching revolution in a campaign, promising an end to inequality, voicing commitment to a wide range of progressive goals – all of these are easy. But once someone promising massive change is in power, he or she has limited ability to fundamentally alter political and economic structures without support. Sustained mass mobilization – including the kind necessary to elect progressive allies at the state and local level – is essential to a progressive agenda. And it’s something we haven’t managed recently.

But we can. We can take all the passions that this campaign has stirred up on behalf of social and political transformation and we can channel it into civil society – into the organizations that work daily to win and sustain progress on a broader progressive agenda, including gun violence, abortion rights, institutional racism, pay equity, family leave, immigration, and campaign finance reform. All of the social media energy, all of the rallying – this can fuel a real revolution from the bottom up. There are already promising signals that this is happening. For example, some Sanders supporters have drafted a plan to harness the campaign’s strength to defeat Trump in the fall, fully aware that a Trump presidency would seriously impede a progressive agenda.

I really want to close on this optimistic note, but I unfortunately can’t. I fear that Sanders’ campaign is becoming cynical, and nothing kills participation in the political process better than cynicism – the overwhelming feeling that the game is fixed and there’s no chance to influence the process. Top Sanders officials dismissed reports of that plan for anti-Trump mobilization by actually saying “we could care less.” The campaign’s response to the vile insults and threats leveled against Nevada’s Democratic Party convention chair was a tepid repudiation of harassment couched in a full throated proclamation that they had been cheated by “the establishment.” One of the texts the convention chair received from an apparent Sanders supporter said, “I would rather vote for Hitler than Hillary.” Let that sink in a bit.

Progressives can certainly squander this moment and decide politics is bull and compromise is capitulation. But that will do nothing to end inequality. If people really think Hillary will not fight for progressive ideals as president, what better way to ensure she does than to stay mobilized, get a progressive Congress, and put pressure on her from outside the White House?

We have a revolutionary moment to challenge inequality. We cannot throw away our shot.[iv]

[i] In political science terms, I would label Sanders as more of a populist than a revolutionary.

[ii] All praise and thanks to Lin Manuel Miranda, from whose brilliant work I have borrowed phrases and concepts.

[iii] There are endless examples of populist movements (and even revolutions) in Latin America failing to address racial and gender inequality. For example, leftist leader and former revolutionary Daniela Ortega in Nicaragua made abortion laws stricter in his country in exchange for support from the Catholic Church.

It was Friday, my fifth day of labor. Unable to keep food down or get more than a half hour of continuous sleep since Monday evening, I was relieved when my midwives decided to speed things up by admitting me to the birth center and rupturing the membranes of my placental sac. And still more relieved when one of their more experienced midwives sat with me, coaxing me to relax and let my body do the work.

But soon after, I was left in the care of the one midwife in the practice I didn’t feel a connection with. It was this new midwife who, in our first meeting at my 40-week visit, had immediately started talking about how they would induce me at 42 weeks, even though I was confident that wouldn’t be necessary. And it was this midwife who, on Monday, had told me over the phone that my contractions weren’t strong enough or regular enough to warrant coming in to the birth center, even though I’d been tracking them all day and they had been 5 minutes apart for over an hour. I sensed she didn’t want to take the trouble to come in to the center and monitor my labor in person.

That conversation affected my labor profoundly. I had been en route to the birth center – with all the certainty a first-time mother could have that I wasn’t imagining actual labor. When she said – no, go back home, wait until it’s been two hours – I suddenly felt even more powerless over the forces that had taken over my body. In a surge of frustration and anger, I began to sob. When my husband and I reached our home and I stepped through the front door, a violent contraction trembled through me, and a fit of nausea sent me running to the bathroom. I couldn’t keep food down the rest of the week.

In the thirteen years since, part of me has remained baffled by the helplessness I demonstrated during those five days. In my personal and professional life, I work daily on behalf of gender equality. I experience the privileges that U.S. society gives to white, upper middle class women, particularly those above the age of 30. I was not, in short, the kind of woman who regularly experiences discrimination at the hands of health providers.

And I planned my birth precisely to avoid an imbalanced power dynamic. Wary of the lack of control that I often felt interacting with doctors during my life, I had long known that I wanted midwives to assist me in childbirth.

Yet never once did I express my discomfort with the new midwife, never once spoke up with a strong opinion about my care, never once even questioned the dose of castor oil they gave me on Friday to speed up labor (as if that would stay down when the Haagen Dazs milkshake a couple days before hadn’t). I didn’t ask the comforting midwife to stay, and I didn’t say I wanted someone other than the new midwife to attend my labor. Against my better judgment, in my exhaustion, I even accepted the lithotomy (flat on the back) position for the seemingly endless pushing stage when the midwife insisted that was what the baby’s position required.

The truth is I wasn’t powerless – I’m sure if I had asserted myself at the outset, I could have had a smoother birth. But I was focused – getting that baby out of my body was my only goal, and anything else felt like a distraction, a waste of precious energy. I made myself powerless, because that’s what I needed to do at the time. Powerless in the face of strong contractions, and powerless in the face of the threat that I would be transferred to a hospital if my labor didn’t speed up. Powerless to even make the midwifery practice aware of my complaints afterwards, because after all, I ended up with a healthy baby.

If I felt powerless, as someone who knows and defends women’s rights on a daily basis, as someone who had the ability to seek out providers who would listen to me, as someone who benefits from so many privileges, what must women around the world feel?

I have since learned a great deal about what women around the world are experiencing. Thanks to the diligent efforts of global advocates, and the women who have bravely spoken up, we know that feelings of powerlessness are all too common during childbirth – in the face of verbal and sometimes physical abuse. We also know that layers of discrimination – due to race, age, religion, poverty, HIV status – add to these experiences of disrespect and abuse.

Reading birth stories of women who have experienced disrespect and abuse in childbirth, I know how lucky I am. Being turned away, not listened to, not respected, left alone, denied information, not consulted – women experience this kind of treatment daily around the world, and it drives them away from skilled care, causes critical delays in their care – and violates their human rights. I was never physically in danger from the disrespect I experienced. Unfortunately, many women are. For example, the maternal mortality rate in the United States for women of color is shocking – almost four times higher for black women than white women.

Today is the International Day for Maternal Health and Rights. It’s an opportunity to push forward the structural changes necessary to end the silence and power imbalances that all too often accompany childbirth. We can give women the information they need to understand their pregnancies and how powerful they really are. But most importantly, we can create cultures that honor and respect women’s voices, most critically when they are engaged in the amazing, precarious, painful, heartbreaking, earth-shattering process of creating life.

To add your name to the petition to get official United Nations recognition of the International Day for Maternal Health and Rights, see this page

To learn more about the movement to end disrespect and abuse in childbirth, see this brief I wrote for White Ribbon Alliance.

Apologies for the obvious line, but my head is spinning a bit as you have simultaneously demonstrated both your intense fear about theoretical rapes in bathrooms and your apparent disinterest in actual rapes in actual bathrooms.

Your recent vote against an anti-discrimination ordinance seems to have been largely driven by ignorance and fear. Please correct me if I’m wrong. But the swelling conservative reaction to transgender rights is based almost entirely on the infamous bathroom argument: that predatory men will use anti-discrimination policies to pretend to be women and attack them in public restrooms.

The argument is absurd on many levels. Why would men go to the trouble of dressing up as women to carry out rapes? The vast majority of rapes are currently committed with impunity due to low reporting, prosecution, and conviction rates. It’s hard to imagine there are rapists out there who are saying to themselves, “If only there were an anti-discrimination policy in this town, THEN I’d be able to put on a dress and wig to commit rape in the luxury and privacy of a public bathroom!”

But let’s just go with it and say there’s a rapist who absolutely will not commit rape unless he gets to pretend to be a woman to do so. How exactly would an anti-discrimination policy protect him? Are there lots of rapists dressing up as women who are foiled because they are kicked out of the bathroom before they can attack? Can anyone name a single instance where gender discrimination in restrooms has served a protective purpose?

Also, denying rights to an entire group of people because of an irrational fear of something that has literally never happened is pretty much the definition of discrimination.

But to make matters worse, Houston, even as your vote places a faulty argument about rape prevention paramount to human rights, one of your police detectives – with a best supporting role from a local TV station – demonstrated just how seriously rape in bathrooms is taken. As reported on Jezebel, a 12-year-old girl (i.e. under the age of consent) was lured into a CVS bathroom by a man in his 20s (who was not, in fact, pretending to be a woman at the time). The detective told the local ABC affiliate that the girl, “was not necessarily all that unwilling” before helpfully adding that her willingness does not matter because she was 12. The news report added to the focus on the victim’s willingness by referring to what happened as “sex” and not “rape.”

Why even bring up the degree of her willingness if, as pointed out, it does not matter from a legal perspective? Was she only kind of unwilling? How unwilling does a 12-year-old have to be, and how does she have to show it, for the police to present it to the media as a straight up crime?

No. You do not get to pretend rape prevention is so important to you that you’ll vote away rights that are on the books, and then turn around and shrug when a 12-year-old is raped. You just don’t.

All this is on the heels of the outrage directed at the Department of Education for asking an Illinois school to accommodate a transgender girl’s request to be allowed to change in the same locker room as other girls on her team. In this case, opposition seems to be focused not so much on the possibility of rape, but on the possibility that a girl might see a penis. (Note that the exposure argument is exclusively applied to integration of transgender girls/women with cisgender girls/women, and not to integration of transgender men. Only girls and women are apparently irredeemably scarred by seeing the genitalia of the opposite sex.) In the New York Times, a Focus on the Family representative was quoted as saying, “girls should not have to risk being exposed to boys in locker rooms, changing rooms, and restrooms.”

Given their comments, I’m really curious about what these people do in locker rooms and restrooms. Personally, I have successfully used public restrooms my entire life without once seeing what’s in the pants of anyone else. And in locker rooms, the norm seems to be eyes front/down and dress quickly. One only needs to listen to transgender people to know that they don’t see access to the appropriate locker room as an opportunity to make others uncomfortable. They see it as a right, much like equal access to public facilities has been guaranteed for others in this country.

So Houston, and everywhere else considering restricting people’s rights, keep the following in mind:

Transgender people are the ones who are most vulnerable in locker rooms and bathrooms. Not cisgender people.

Transgender people, if they have not surgically transitioned, are unlikely to be super excited to flaunt their genitalia, given they don’t identify with these body parts.

“Privacy” does not mean you have a right to never be uncomfortable. Living in a diverse society means sometimes you have to accept that your comfort does not trump other people’s rights.

Above all, no one should vote on these issues until they educate themselves – preferably by listening to the perspectives of transgender people themselves.

It was a room filled with feminists. Or at least one could have assumed as much by the meeting’s theme of gender and international development. Panelists and presenters tackled pressing and difficult global issues that undermine women’s wellbeing: genital cutting, rape as a weapon of war, child marriage, gender-based violence, HIV, and family planning. It seemed we had all our gender and development bases covered. But as the event closed, it struck me: there had not been one mention of abortion.

Gender equality has become a major focus in international development circles, with the Obama administration responsible for a number of positive policies that mandate improved attention to the needs and rights of women and girls. These policies in turn have spawned massive investments in gender expertise within the global development set. Yet there is a peculiar, but predominantly unremarked, feature of the international development industry around gender that defies logic on its face: silence on one of the biggest threats to women’s health and human rights – unsafe abortion.

It’s not like unsafe abortion is an easily overlooked issue when you work in development. You would have to deliberately blind yourself to something that 21.6 million women experience every year, causing 13% of maternal deaths and 1.5 million years of healthy life lost to injury. Addressing the consequences of botched abortions is a major drain on developing countries’ health systems and economies. The impact of illegal abortion crosses sectors – keeping girls out of school and women away from work, or forcing girls and women to bear and support children they would have chosen not to have.

You can’t ignore it from a gender equality and human rights angle either. Many of the same countries that deny women and girls access to reliable and affordable contraception, comprehensive sex education, and communities or households safe from sexual assault also punish women if they have an abortion, denying their right to decide the number and timing of their children. Some countries, like South Africa, have liberalized their abortion laws, yet still do not provide access to what is a very safe procedure when conducted by trained professionals in sanitary conditions. As a result, even women seeking legal abortion are often forced to seek care from untrained providers.

Under normal circumstances, such a glaring and universal issue with clear roots in gender inequality and government control of women’s reproductive lives would be a priority for those concerned with gender and international development. But “normal” has been severely warped out of shape by U.S. laws and their very eager watchdogs in Congress. These laws prohibit U.S. foreign assistance funding for abortion when used “as a method of family planning” (the Helms Amendment, 1973) and for advocacy efforts around abortion rights The Siljander Amendment, 1981).

We have a pro-choice administration, but still these laws are interpreted far more stringently than their original intent. Even in cases when abortion falls well outside a family planning purpose, such as for girls and women raped in conflict zones, the U.S. offers no funding. But it is the self-censorship I find most startling, with administration officials hesitant to speak publicly about the global epidemic of unsafe abortion. Outside of organizations working on and committed to reproductive rights, there is almost complete silence among international development groups.

This is the insidious way longstanding U.S. policy works. You can sit in a room filled with people who unanimously and ardently believe that gender inequality is one of the most significant barriers to international development and never – not once – hear the word “abortion” uttered.

At a recent meeting on women and global health, I had an opportunity to raise the issue, asking the panel (who had not mentioned abortion) how we could increase access to safe abortion over the next two decades. I could have asked about any other topic – about sex workers, drug users, or genital cutting – and received a response based on human rights and the latest public health evidence. But with this question, I immediately felt as though I had thrown a grenade into the room, and the discomfort among the panelists was palpable. They apparently had no expectation that the topic would come up, and had very little interest in giving more than a cursory response. When I left the meeting, even though on an intellectual level I knew that it was a perfectly legitimate question, part of me felt like I had just committed professional suicide, or at the least a very unfortunate faux pas.

We know how to prevent women from dying or being injured by unsafe abortion. But when we stop ourselves from discussing the subject in meetings of people who care about gender, human rights, or maternal health, we have accepted failure as the default and we show no interest in seriously grappling with the status quo.

The Helms Amendment hasn’t budged for forty years. If the wall of silence around unsafe abortion is not lifted by those who care deeply about women’s empowerment and equality, we are complicit in its permanence for another forty. And when the women we work with around the world ask us why, what will we tell them?

This was originally posted in the Bill and Melinda Gates Foundation’s Impatient Optimists blog on December 5, 2012

Gender inequality is HIV’s best friend. Fortunately, the converse is also true – gender equality is HIV’s nemesis. And by fighting HIV through advancement of gender equality, we reap all kinds of additional benefits.

Women account for slightly more than half of all people living with HIV, and the majority contract it through sex with long-term partners. Young women account for nearly 75 percent of infections among people ages 15-24 in sub-Saharan Africa. Girls who bear the brunt of two classic symptoms of gender oppression — being married off young or kept out of school — are particularly vulnerable to HIV. Gender violence – whether it’s rape used as a weapon of war, physical violence in the home that takes away women’s power to suggest condom use, or emotional violence that keeps women silent and untreated if they are diagnosed with HIV – is like gasoline to the spread of HIV.

In global health, people frequently talk about “entry points” where people using one service can be reached by providers of other services (such as providing family planning services to women who have just given birth). Here’s a link to a panel discussion at Woodrow Wilson Center during which I argue that there these can also be “exit points” – if women are mistreated and disrespected during maternity care, their impression of health care providers in general may be negatively affected. We need to integrate services to meet the needs of clients, but also must be attentive to their human rights.

In an HIV prevention focus group in Malawi, a woman raised her hand. She asked the facilitator if he would be able to go to the condom company and ask them to make a condom for women. That way, she and the other women in her community would have options to protect themselves from HIV, and plan their families. They wouldn’t have to rely on their partners to initiate condom use. They could have the opportunity to protect their own health.